Provider Demographics
NPI:1316321631
Name:LUCAS AND THOMAS FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:LUCAS AND THOMAS FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-285-3140
Mailing Address - Street 1:1600 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4533
Mailing Address - Country:US
Mailing Address - Phone:912-285-3140
Mailing Address - Fax:912-285-0260
Practice Address - Street 1:1600 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4533
Practice Address - Country:US
Practice Address - Phone:912-285-3140
Practice Address - Fax:912-285-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1114941184OtherGEORGE W.THOMAS, D.D.S.
GA1790946622OtherJASON W. LUCAS, DMD